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General NPI Number Information
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NPI Number | 1407905904
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Entity Type | Organization
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Legal Business Name | ULTIMATE REHAB INC
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 09/10/2007
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Provider Practice Location Address
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Address Line | 1770 NE MIAMI GARDENS DR
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City | MIAMI GARDENS
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State | FL
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Zip | 33179-5301
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Country | US
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Telephone | 305-944-8290
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Fax | 305-944-8061
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Provider Business Mailing Address
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Address Line | 1770 NE MIAMI GARDENS DR
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City | MIAMI GARDENS
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State | FL
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Zip | 33179-5301
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Country | US
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Telephone | 305-944-8290
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Fax | 305-944-8061
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Authorized Official
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Title or Position | PRESIDENT
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Name | MILAGRO MARISELA GONZALEZ
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Credential | PT
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Telephone | 305-944-8290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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